I mention him because his key message is that the world is changing fast and we have to adapt, change our business models, take risks, and do things different (and consciously) lest we have change thrust upon us. Seth’s message is: design your future or have it done for you.

Our health systems are in this state right now. I use systems in plural because the most common thing that people think of when I say that I work on issues of health is the health care system. I work in health promotion — that branch of public health that seeks to keep people healthy, prevent illness, and design ways to help everyone achieve their best. I use design here consciously, because much of what health promotion does is seek to shape the conditions in which health is created, maintained or compromised – even if that word isn’t used explicitly. Many of these are what are called the social determinants of health. These include one’s level of education, race, relative income, employment opportunities, and access to health care, among others.

Yet, design is a foreign concept in public health. To many of my colleagues, design is something related to product development or something to that extent. Even as public health begins to embrace art as a means of engaging people, design and design thinking remain somewhat unknown. This is in spite of the fact that much of what public health does is design-oriented; it is the conscious shaping of settings, conditions and human activity to promote health and protect people from harm.

I’ve often said that my course on health behaviour change is about training public health professionals on ways to overcome bad (unhealthy) design in our communities, policies, and programs.

What I have been seeking to do is introduce the concept of design to a wider audience within the health professions and have been pleased with the early uptake. Speaking with colleagues in a variety of public health areas, there seems to be a growing discontent with the way things are being done and how our programs and policies are being created. The idea of engaging the public is something not unfamiliar to public health, yet it is something done out of a sense of values and respect, and less about purposive design. What health promotion adds is its explicit statement of values, while design adds value through its conscious application of strategic planning to the creative process.

While designers have taken to contribute to social determinants like education, there has been much less attention paid to the ways in which people learn, the sources of that knowledge, who accesses education in the first place, and the literacies required to fully benefit from modern information production landscapes. This is the domain of health promotion. It is also where we can make the most impact.

Consider something like tobacco use, where more than 500 million people alive today are expected to die from it. From the cigarettes themselves to the ways in which they are used, sold, regulated and marketed are all designed solutions.

We are on the cusp of major food price increases and potential shortages on a global scale. How we address these problems in ways that don’t exacerbate the gap between the rich and poor or create further unintended consequences is important. Without consideration of the ways we design our markets, our policies and the opportunities for people to engage in the decision making process, the creation of the solutions, and the discussion about what not just how such interventions can instill health we are losing an opportunity to get the best of design into health.

At the same time, we need design to go beyond simple end-user participation into true engagement with the public on a level that goes beyond strategy and tactics and more towards values.

Complex problems like chronic disease, health inequity, access to health care, civic engagement, global migration, and food security are ones that require a diverse set of perspectives, abductive (design) thinking, systems perspectives and ways to bring them all together. Design is a way to do that. Health promotion, rather than health care is the focus that will get us from treating problems to developing solutions.